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What It Is

​The Kentucky Women's Cancer Screening Program of the Department for Public Health provides breast and cervical screening and follow-up services, professional education, public education, outreach, quality assurance and surveillance. Screening and follow-up services are provided by local health care professionals through contracts with local health departments. The program is funded by both state and federal funds and is part of the National Breast and Cervical Cancer Early Detection Program.

Services

Breast cancer screening

Prior to 1990, local health departments in Kentucky provided limited breast cancer screening services consisting of instruction on breast self-examination and counseling on risk factors for breast cancer. When new state funds became available in 1990, local health departments in all 120 counties expanded their services to include clinical breast exams, referrals for screening mammograms and referrals for follow-up diagnostic tests.     

In 2005, 12,799 women in Kentucky were screened through the Women's Cancer Screening Program. 

Cervical cancer screening

Cervical cancer screening (Pap tests) have been provided through local health departments since the 1960s. Pelvic examinations and referrals for diagnostic tests are available to eligible women at local health departments in Kentucky.

Income Eligibility

The Kentucky Women's Cancer Screening Program provides low-cost mammograms and Pap tests through health departments in every county. 

Three factors are used to determine eligibility for breast cancer screening:

  • age
  • income 
  • uninsured (no private insurance, no Medicaid, no Medicare).

Women age 40-64 who meet guidelines are eligible for screenings every year. Women younger than 40 are eligible to receive screening services if they have a family history of breast cancer.

Low-cost annual Pap tests are provided to uninsured women with incomes at or less than 250 percent of the poverty level beginning three years after the onset of sexual activity or no older than 21 years of age.

About the Program

Recognizing the value of screening and early detection, Congress passed the Breast and Cervical Mortality Prevention Act of 1990 which authorized the Centers for Disease Control and Prevention (CDC) to provide critical breast and cervical cancer screening services to underserved women, including older women, women with low incomes and racial and ethnic minority women.

Through its landmark National Breast and Cervical Cancer Early Detection Program, CDC now supports screening activities in all 50 states, five U.S. territories, the District of Columbia and through 15 American Indian/Alaska Native organizations. By October 1997, more than 1.5 million screening tests had been provided by the NBCCEDP.

Fiscal year 1999 appropriations of approximately $158 million enabled CDC to expand access to screening and follow-up services, increase education and outreach programs for women and health care providers and improve quality assurance measures for screening.

In 1990, Senate Bill 41 was passed, establishing a breast cancer screening program in the Kentucky Department for Public Health. In addition to setting out general guidelines for the operation of a breast cancer screening program, SB 41 established a Breast Cancer Advisory Committee for the purpose of advising the Commissioner of the Department for Public Health on developing guidelines for breast cancer screening services. The 1994 General Assembly made amendments to the original statute with passage of House Bill 931 which clarified statute language, added three new members to the Breast Cancer Advisory Committee and expanded reporting requirements to the Governor and Legislature. The 1998 General Assembly again amended existing law designating Nov. 1 as the due date for the annual report and adding a radiologist to the Advisory Committee.

References

Understanding Breast Cancer Treatment:  A Guide for Patients
This booklet was developed by the National Cancer Institute to help women who have been diagnosed with breast cancer make treatment decisions. The booklet can be obtained by contacting the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237)

Providers Practice Prevention

Contact:  Kris Paul, MSN, APRN
University of Louisville Kentucky Cancer Program
501 E. Broadway, Suite 160
Louisville, KY 40202
Phone: 502-852-6318
Fax 502-852-4554

Cancer Screening Information

​Breast cancer forms in tissues of the breast. It occurs in both men and women, although male breast cancer is rare. 

The American Cancer Society estimates for 2011: 

  • New cases: 230,480 (female) 
  • Carcinoma in situ (CIS): 57,650
  • Deaths: 39,520 (female) 

Everyone, especially women, between the ages of 21 to 64 years should do monthly breast self-examinations. Studies show that regular breast self-exams combined with annual exams by a health care provider, improves the chances of detecting cancer early. The more you examine your breasts, the more easily changes will be detected. Breast self-exam is an essential part of taking care of yourself.

Risk Factors

A risk factor increases your chances of having a disease. Simply being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.

Age

Your chances of getting breast cancer will increase with age. About two out of three women with invasive breast cancer are age 55 or older when the cancer is found.

Family History

Breast cancer risk is higher among women with close blood relatives from either the mother or father's side of the family who have or had this disease. Having a mother, sister or daughter with breast cancer about doubles a woman's risk. Genetic mutations are linked to 5 to 10% of breast cancers. BRCA1 and BRCA2 are the most common. Women can have a blood test preformed to see if they are positive for this gene. It's important to note that 70 - 80 percent of women who get breast cancer do not have a family history of this disease.

Early periods/late menopause

Women who began having periods before age 12 or who went through menopause after the age of 55 have a slightly increased risk of breast cancer.

Previous Breast Cancer 

If you have had cancer in one breast your chances increase of having it in the other breast.

Race

White women are slightly more likely to get breast cancer than are black women, but black women are more likely to die of this cancer. Asian, Hispanic and Native American women have a lower risk of getting and dying from breast cancer.

Dense Breast Tissue

Dense breast tissue means there is more gland tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer. Dense breast tissue can also make it harder for health care providers to spot problems on mammograms.

Alcohol use

Use of alcohol is clearly linked to an increased risk of getting breast cancer. Women who have one drink a day have a very small increased risk. Those who have two to five drinks daily have about 1½ times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink.

Weight 

Being overweight or obese after menopause increases one's risk. The American Cancer Society recommends you maintain a healthy weight throughout your life and avoid gaining too much weight.

Signs and Symptoms

Generally, early breast cancer does not cause pain. Even so, a woman should see her health care provider about breast pain or any other symptom that does not go away.

A change in how the breast or nipple feels - You may experience nipple tenderness or notice a lump or thickening in or near the breast or in the underarm area.

A change in how the breast or nipple looks - This could mean a change in the size or shape of the breast or a nipple that is turned slightly inward. In addition, the skin of the breast, areola or nipple may appear scaly, red or swollen or may have ridges or pitting that resembles the skin of an orange.

What Can You Do?

Mammograms play a key role in helping to diagnose breast cancer. A routine mammogram should start at least by the age of 40 or at your health care provider's discretion or when there are changes noted in your breast.

A clinical breast examination should be done by age 20 and at least every three years when you have a physical examination with your health care provider.

Changes in your breast may or may not be cancerous but early detection of a lump can be a measure in helping you along the road to diagnosis and treatment if needed.

​The cervix is the lower part of the uterus. The body of the uterus (the upper part) is where a baby grows, The cervix connects the body of the uterus to the vagina (birth canal). The goal of screening for cervical cancer is to find cervix cell changes and early cervical cancers before they cause symptoms.

Screening tests offer the best chance to detect cervical cancer at an early stage when successful treatment is likely. Screening can also actually prevent most cervical cancers by finding abnormal cervix cell changes (pre-cancers) so that they can be treated before they have a chance to turn into a cervical cancer. The Pap test is the best way we have to screen for this type of cancer.

Risk Factors

  • multiple sex partners
  • human papillomavirus (HPV) infection
  • smoking or exposure to second hand smoke
  • HIV infection
  • chlamydia infection
  • dietary factors
  • hormonal contraception
  • multiple pregnancies
  • exposure before birth to the hormonal drug diethylstilbestrol (DES)
  • a family history of cervical cancer

What Can You Do?

A Pap test can find changes in the cervix that can be treated before they become cancer. The Pap test is also very effective in finding cervical cancer early, when it is highly curable. Contact your Local Health Department or health care provider for an appointment today.

Pap Screenings

  • The American Cancer Society recommends women should begin having a pap test about three years after they start having sex, but no later than age 21.
  • The pap test should be done every year if a regular test is performed, or every two years if the liquid-based pap test is used.
  • Talk with your health care provider about how often to have this test done.
  • Prior to having your pap test:
    • do not douche, use tampons or vaginal creams for two days before test
    • do not have sex two days before test
    • schedule your test for when you will not be having your period.

​Ovarian cancer forms in tissues of the ovary, one of a pair of female reproductive glands in which the ova, or eggs, are formed. Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells).

The National Cancer Institute estimates for 2011:

  • New Cases: 21,990 
  • Deaths: 15,460

Risk Factors

Age

The risk of developing ovarian cancer increases with age. You are at risk if you are middle-aged or older. Ovarian cancer is rare in women younger than 40. Most ovarian cancers occur in woman after the age of 50 and develop after menopause. Half of all ovarian cancers are found in women older than 63. About 1 out of 100 woman will get ovarian cancer by age 70.

Women who have had children have a lower risk of ovarian cancer than women who haven't. The risk drops with each pregnancy and breastfeeding may lower the risk even further. Using oral contraceptives (also known as birth control pills or the Pill) also lowers the risk. 

Family History

Ovarian cancer can run in families. Your ovarian cancer risk is increased if your mother, aunt, sister or daughter has or had ovarian cancer, the higher your risk. The risk increases as the number of relatives with ovarian cancer increases. Increased risk for ovarian cancer can come from your mother or father's side of the family.

Signs and Symptoms

Early cancers of the ovaries tend to cause symptoms that are more commonly caused by other things. 

  • Vaginal bleeding or discharge from your vagina that is not normal for you.
  • Abdominal swelling or bloating (due to a mass or accumulation of fluid)
  • Pelvic pressure or abdominal pain
  • Difficulty eating or feeling full quickly
  • A change in your bathroom habits, such as having to pass urine very badly or very often, constipation or diarrhea.

Most of these symptoms also can be caused by other less serious conditions, but when the symptoms are caused by ovarian cancer they tend to be more severe. By the time ovarian cancer is considered as a possible cause of these symptoms, it may have already spread beyond the ovaries.

Prompt attention to symptoms may improve the odds of early diagnosis and successful treatment. If you have symptoms similar to those of ovarian cancer almost daily for more than a few weeks, and they can't be explained by other more common conditions, report them to your healthcare professional -- preferably a gynecologist -- right away.

Screenings

Since there is no simple and reliable way to screen for any reproductive cancers except for cervical cancer, it is especially important to recognize warning signs and learn what you can to reduce your risk. Tests used most commonly to screen for ovarian cancer: transvaginal ultrasound, rectovaginal exam and CA-125. 

  • Transvaginal ultrasound is a test that can help find a mass in the ovary, but it can't actually tell which masses are cancers and which are not.
  • A rectovaginal exam is where a health care provider examines the vagina and rectum while at the same time palpates the abdomen with the other hand. This type of exam allows the health care provider to examine and identify abnormalities, especially on the uterus and ovaries more clearly.
  • CA-125 is a blood test that checks for a protein that is higher in many women with ovarian cancer. The problem with this test is that conditions other than cancer can also cause high levels of CA-125. In addition, someone with ovarian cancer can still have a normal CA-125 level.

Diagnosis

About 20 percent of ovarian cancers are found early. When ovarian cancer is found early at is localized, about 94 percent of patients live longer than 5 years after diagnosis. During a pelvic exam, the health care professional feels the ovaries and uterus for size, shape and consistency. Although a pelvic exam is recommended because it can find some reproductive system cancers at an early stage, most early ovarian tumors are difficult or impossible for even the most skilled examiner to feel. Pelvic exams may, however, help identify other cancers or gynecologic conditions. Women should discuss the need for these exams with their healthcare provider. 

Although the Pap test is effective in detecting cervical cancer early, it is not a test for ovarian cancer. Rarely ovarian cancers are detected through Pap tests, but usually these are at an advanced stage.

Documentation

Contact Information

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